Tag: Cuijpers

Reading of the Week: Running vs SSRIs for Depression – the new JAD Paper; Also, Climate Change & Mental Health, and Understanding My Schizophrenia

From the Editor

“Go for a Run to Beat Depression – It’s Just As Effective As Taking Medication”

– New York Post

“Running could be just as effective at treating depression as medication, scientists find”

– The Independent

Patients often ask what they can do to get better from their depression. Should we be advising them to put on a pair of runners and go for a jog? A new paper published in the Journal of Affective Disorders seems to suggest as much – and it’s caused a bit of media buzz. In the first selection, Josine E. Verhoeven (of Vrije Universiteit Amsterdam) and her co-authors describe this 16-week study that offered 141 people with depression and/or anxiety either a running intervention or medications, and looked at several mental and physical health outcomes. “We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes… the interventions had a significantly different and often contrasting impact on several physical health outcomes, with more favorable outcomes for those in the exercise intervention.” We consider the paper and its implications.

In the second selection, Pim Cuijpers (of Vrije Universiteit Amsterdam) and his co-authors discuss climate change and mental health in a new viewpoint for JAMA Psychiatry. Though they note the lack of high-quality research in the area, they argue that it would disproportionately affect low and middle-income nations. They then point a way forward. “There is no doubt that climate change will have a major impact on mental health in the coming decades.”

And in the third selection which is written anonymously, a person with schizophrenia talks about his experiences in a paper for Schizophrenia Bulletin. He tries to empower himself, working to limit side effects and cope with the voices. “My brain disease is incurable, but it is not an excuse for me to be irresponsible or to give up on life.” 

DG

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Reading of the Week: CBT for Depression – the Latest Evidence; Also, Digital Mental Health (World Psych) and Dr. Castro-Frenzel on Her Cancer (JAMA)

From the Editor

Cognitive behavioural therapy is widely used for the treatment of depression – but the last significant meta-analysis was published a decade ago. What’s the latest evidence? 

In the first selection, Pim Cuijpers (of the Vrije Universiteit Amsterdam) and his co-authors try to answer this question with a new meta-analysis including more than 400 randomized trials with almost 53 000 patients (yes, you read that correctly). In this World Psychiatry paper, they compare the therapy with controls, other therapies, and medications. They write: “We can conclude that CBT is effective in the treatment of depression with a moderate to large effect size, and that its effect is still significant up to 12 months.” We consider the paper and its clinical implications.

Beck: the father of CBT

In the second selection, Dr. John Torous (of Harvard University) and his co-authors look at digital mental health. Despite widespread use of smartphones – perhaps 80% of the world’s population now has access to one – “digital mental health is not transforming care.” In this Editorial for World Psychiatry, they wonder why. They also point a way forward: “Developing a new generation of digital mental health tools/services to support more accessible, effective and equitable care is the true innovation ready to be stoked today by each person who becomes empowered to connect, set up, engage, start/stop, and demand more from mental health technology.”

Finally, in the third selection, Dr. Karla Castro-Frenzel (of the University of Central Florida) writes about a patient with advanced lung cancer. As it turns out, she’s that patient. In this personal essay published in JAMA, she writes about being a doctor and a patient. “My ultimate hope… is that we can create space for illness as well as wellness. In helping our colleagues feel safe and supported when they become patients, we rehumanize our environments and our very selves.”

DG

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Reading of the Week: Cuijpers on Depression Treatment (WP); Also, Suicide (NEJM), and Sinyor on DeRozan & Depression (Star)

From the Editor

How to treat depression? How do we approach suicide? Who is the greatest Raptor of all time?

This week, we consider three pieces.

In the first selection, Pim Cuijpers (Vrije Universiteit Amsterdam) and his co-authors do a network meta-analysis of depression treatment, weighing psychotherapy, pharmacotherapy, and the combination of the two. They find: “combined treatment is more effective than psychotherapy or pharmacotherapy alone in the short‐term treatment of moderate depression, and there are no significant differences between psychotherapy and pharmacotherapy.”

In a short New England Journal of Medicine paper, Drs. Seena Fazel (Oxford University) and Bo Runeson (Karolinska Institutet) review a topic of relevance to all clinicians: suicide. “Management of suicidality calls for a comprehensive approach to assessment and treatment.”

TORONTO, ON - SEPTEMBER, 25 DeMar DeRozen poses for photos. It was media day for the Toronto Raptors at their training facility, the BioSteel Centre. Coaches and players met with media, answered questions and had a variety of photographs taken. (Richard Lautens/Toronto Star via Getty Images)Yes, we talk about basketball this week

Finally, in the third selection, the University of Toronto’s Dr. Mark Sinyor writes about basketball and his favourite Raptor – and, yes, stigma.

DG

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Reading of the Week: Too Few Psychiatrists? Anderssen on the Gap in Access (Globe); Also, Cuijpers on Success in Depression Treatment (Expert Review)

From the Editor

After a break, the Readings are back. In the coming weeks, we will consider important papers on depression treatment, cannabis, help for the homeless, and more.

This week, there are two selections.

In the first selection, we consider the new Globe and Mail essay by reporter Erin Anderssen on the supply (or the lack of supply) of psychiatrists across Canada. This essay does a sparkling job of pulling together stories and reports, and includes an overview of the literature. It paints a familiar, if unsettling, picture of need unmatched by availability, and includes interviews and original data analysis.

She writes: “The modern psychiatrist can’t be everywhere. So they should be where Canadians need them most.”

We summarize the essay and some of the larger questions raised.

anderssenErin Anderssen

In the second selection, the Vrije Universiteit Amsterdam’s Pim Cuijpers writes about depression and treatment. Thinking about successful care, he asks a simple question: “When patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well?”

DG

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Reading of the Week: CBT for Depression – What Really Works? The New JAMA Psychiatry Paper

From the Editor

“It changed my life.”

A few years ago, a patient described to me how helpful cognitive behavioural therapy was for him. CBT wasn’t his only treatment – he had a couple of medication trials – but he found the psychotherapy to be very helpful.

Others have had a similar experience, but CBT isn’t widely available in Canada; Puyat et al. found in a Canadian Journal of Psychiatry paper that the vast majority of people with depression don’t receive any form of psychotherapy or counseling. How can we address this access gap? Could different forms of CBT work including those that are less resource intensive? What to make of self-help?

In this Reading, we consider a new paper by Vrije Universiteit Amsterdam’s Pim Cuijpers and his co-authors that seeks to answer these questions. They use a network meta-analysis to compare five treatment formats with each other and control conditions (waiting list, care as usual, and pill placebo). Their conclusion: “This study suggests that group, telephone, and guided self-help treatments are effective interventions that may be considered as alternatives to individual CBT.”

dr-aaron-beck-at-work-595048284-5af62b4dae9ab80036aca7faAaron Beck: How to deliver the CBT he has championed (and should we all wear a bow tie)?

In this Reading, we consider the big paper and its big result, and the accompanying editorial by the University of Pittsburgh’s Dr. Holly A. Swartz and Jay Fournier.

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

DG

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Reading of the Week: The Best of 2016 (and a Look Ahead to 2017)

From the Editor

It’s a Reading of the Week tradition that we end the year by considering the best of the previous 12 months.

And this year we have had great material to consider. Readings were drawn from diverse publications, including journals, but also newspapers and magazines; one Reading was a speech given by the Prime Minister of the United Kingdom. (On the rich diversity of material, I made a similar comment last year.)

If once no one seemed to discuss mental illness, today these issues are being talked about.

But instead of just looking back, let’s take a moment to look ahead.

For those of us concerned about mental health services, 2017 looks like it will be a great year.

Consider:

· Though the provinces and the federal government failed to make an historic deal in 2016 that would invest in mental health services, federal and provincial ministers of health all agree that mental health needs to be a priority, and some type of deal is likely to happen.

· In 2016, Starbucks Canada made headlines for its investment in mental health benefits for employees; it’s highly likely that other companies will follow this lead in the coming months.

· In the past year, more people spoke out about their mental health problems, including a famous singer and an Olympic swimmer; in 2017, more people will find their voice and share their stories.

So – Happy New Year.

Thanks to all those who made suggestions for Readings. And thanks to Dr. David Goldbloom for his three guest contributions, as well as to my father and to my wife for their editing.

There will be no Reading next week.

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Reading of the Week: What’s New in Psychotherapy – The Cuijpers et al. Paper

From the Editor

What’s new in psychotherapy?

If there is one area of psychiatry that seems to have been transformed in recent years, it’s psychotherapy. Not surprisingly, then, past Readings have looked at the expanded role of short-term, evidenced-based therapies – in particular, Cognitive Behavioural Therapy, or CBT.

Today’s psychotherapy: a long way from Freud

Over the next two weeks, we’ll look in more detail at new developments in psychotherapy.

This week. A major new review of IPT.

Next week. An overview of psychotherapy developments.

This week, we consider a new paper published in The American Journal of Psychiatry on Interpersonal Therapy, or IPT. This paper is clear, lucid, and worth reading.

Is there evidence for IPT? Yes – and more than just for depression.

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